The Power of Touch
Hands-on Physical Therapy has immense value for people living with pain and stiffness. Recently, there has been a lot of controversy in the chiropractic, physical therapy, and health fields that address pain centered around whether hand-on manual therapies are effective in treating pain and other conditions. As Physical Therapists, we are trained in soft tissue mobilization, joint mobilizations, and even high-velocity, low amplitude thrusts (basically an adjustment - we’re just not allowed to call them that). These techniques are often used for a specific intent - to help reduce pain, allow more efficient movement, and to gain more range of motion.
There is evidence that points to manual therapies NOT being effective in reducing pain outcomes and functional improvement. However, there is also evidence to show that manual therapies ARE effective in treating pain and improving outcomes. Much like anything in the medical community, we can find articles and research that support or negate the stance that we are looking at. This starts the narrative of controversy in our world. Some providers do make ridiculous claims about what their techniques can do and what they can treat (I’ve seen a chiropractor try to treat a heart attack with a cervical adjustment - come on!!!). But manual techniques and bodywork definitely have a time and place! Just like exercise and activity has a time and place.
Evidence-based medicine is a 3 part system - the literature and research, the clinical expertise, and the patient preference. For example, if you are only treating based on what research tells you, you are not practicing evidence-based medicine. We must take into account what works in the real world and take into account contextual factors around the individual in front of us. Therefore, a more holistic approach is necessary!
We are huge believers in hands-on therapies for pain reduction, improvements in range of motion, and efficiency of movement. But we are also realistic about what techniques and therapies will help and which one’s will not. This is where our clinical decision making and education comes into play! Every PT clinic is different, and many are transitioning toward more of an exercise-only based approach. But this isn’t for everybody!
What does human touch and manual therapies actually do? Touch has been shown to have some minor structural/mechanical benefits to certain tissues in the body, but it also has a vast influence on the neurological system and endocrine system (hormones!).
Mechanically, certain manual therapies can improve the sliding and gliding efficiency of the many layers of tissue reducing the difficulty and resistance of movement. For example, if a PT uses certain techniques on a quad muscle that is creating tension and stiffness at the knee cap, then that person will likely be able to move better through knee motions after the technique. Physiologically, we are also going to bring blood flow and circulation to the region we are working on, which will ultimately help with healing.
As for the neurological effects, this is where the real magic lies. With touch, we are increasing sensory input through the skin, fascia, and muscle tissue via pressure which is sent to the brain. The brain then interprets that sensory input and provides an output resulting in a cascade of neurological signals to the region we are working on. This includes release of endorphins, endogenous pain relievers, and even signals to the muscles to decrease the amount of tone (resting contraction - think of this as tightness or stiffness) they have in them.
Touch can also release hormones such as oxytocin, dopamine, and serotonin that help make us feel good! It can also reduce cortisol and norepinephrine (our stress response hormones). Touch is one of the BEST tools that can help someone from a sympathetic state (fight or flight) to a parasympathetic state (rest and digest). The parasympathetic state is our state of calmness and this is where a lot of healing takes place. And we can’t forget about placebo - even if it is doing nothing for us mechanically, the belief that it is doing something good for us can have great positive effects!
At Pacific Standard Physical Therapy, we utilize a mixture of treatment techniques that involve hands-on bodywork and therapeutic exercise/ neuromuscular re-education that helps provide long term results. This is true evidence-based practice - treating the individual with special considerations about their own unique factors. Not everyone is appropriate for hands-on physical therapy, but there are a lot of individuals that will benefit from the power of touch!
Come see why and how we are different at Pacific Standard Physical Therapy!
All the best!
Justin LaLonde, DPT